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Medical Billing and Coding Outsourcing in the Wake of Changing RCM

December 01, 2014

Restructuring the process of payment collection and issuing of medical bills is a continuous process. There is a growing pressure among the billing agencies, hospitals and insurance companies every day to restructure the payment procedure. This leads to the question whether or not to outsource these services. The answer to this depends on a range of factors such as the state of finances, age of the business, size of the healthcare facility, etc.

Cons of In-house Medical Billing Process

A hospital doing all this administration work on their own is a difficult process because it involves higher costs, bigger liabilities, and larger support issues. For example, medical billing becomes a largely neglected department when done in-house. Aspects such as unappeased claim denials, ignored forms, etc. mostly go unnoticed since the billing operations are not stringent.

The in-house billing departments are generally managed by two to three staff members within the hospital who have additional administrative responsibility too. Thus, the operations are prone to stalling and it can take a toll even if one of the employees goes on leave. In addition to all the above, the cost of maintaining and updating the health information technology software is high and also needs attention and monitoring at regular intervals. Also, in these times of ever changing compliance laws of the revenue cycle management, outsourcing is a better and easier option for physicians in the US. The pros are numerous in this case.

Restructuring the Payment Collection Process

Outsourcing makes it possible to keep a track of the reimbursement claims for the healthcare providers. The electronic billing service also facilitates a smooth and regular flow of communication between the physicians and patients.

Doctors receive their payments regularly and without much delay. As per a recent survey, outsourcing medical billing reduced the waiting period for receiving payments by at least a day. It also increased the hospital’s efficiency as they did not have to spend time completing the adequate paperwork and following up with the insurance carrier.

Increased Transparency and Tracking Ability

Outsourcing the medical coding and billing process enables the much needed tracking facility to the physicians from the billing company. They either supply the comprehensive reports to the doctors on request or give 24*7 access to the process and payment posting, as the clause maybe. This means, you can view the billing phases without actually having to manage or oversee any of the operations. You can also expect a level of consistency from your billing partner. Thus, minimum denials and quicker approval of reimbursements is expected. Denials also, if any, would be appealed by the billing company only.

Benefit of Cost Cutting

Medical billing and coding requires specific kind of software and equipment. Procuring, configuring, updating and maintaining them are a costly affair if it is being done for one hospital alone. However, in case of billing companies, the maintenance and updating the software is not an issue since it is a part of their common infrastructure and clientele. Therefore, it is much more effective than running an in-house billing department in a hospital.

It is the realization of these advantages that many hospitals are now doing away with the in-house billing departments and prefer to outsource medical billing and coding to billing companies.

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